Father's Occupation - Harvest Land Coop
Name:
Birthdate:
Address:
Email:
City:
State:
County of Residence:
Zipcode:
Phone:
Father’s Name:
Age:
Father’s Occupation
:
Mother’s Name:
Age:
Mother’s Occupation
:
Sibling Name:
Age:
School (if attending) :
High School:
Graduation Date:
Address:
Phone:
City: Class Rank
State: (Please attach transcript of grades)
Zipcode:
:
College, Technical School or other Post-High School Program planning to attend:
Major/Area of Study: Please return to:
Application must be received no later than March 1, 2018 to be eligible. Lindsay Sankey, P.O. Box 516, Richmond, IN 47375 or [email protected] Phone: 765.962.1527 | Fax: 765.962.3855
Agricultural Scholarship Application Page 2 of 4
Work Experience - Please list any jobs that you hold or have held: (Employer, Position and Length of Employment)
Other Scholarships or Grants you will be receiving: Name:
Amount: $ $ $
Please provide information about your local newspaper: Name: • •
City:
Phone:
On the attached sheet of paper, list extracurricular/leadership activities. On the attached sheet of paper, prepare a short statement regarding your future career plans .
I understand that I am voluntarily releasing the above information to Harvest Land Co-op, Inc. for the purpose of applying for a scholarship for the upcoming academic year for an agricultural related program. Harvest Land Co-op is authorized to review the information in this context.
semester, quarter or term.
Signed
Date
Application must be received no later than March 1, 2018 to be eligible.
Agricultural Scholarship Application Page 3 of 4
Extracurricular/Leadership Activities Student’s Name: Please list pertinent extracurricular/leadership activities, providing a brief explanation if necessary. (Additional sheets may be used.)
Application must be received no later than March 1, 2018 to be eligible.
Agricultural Scholarship Application Page 4 of 4
Future Career Goals Student’s Name:
(Please limit the statement to this page.)
Application must be received no later than March 1, 2018 to be eligible.
Birthdate:
Address:
Email:
City:
State:
County of Residence:
Zipcode:
Phone:
Father’s Name:
Age:
Father’s Occupation
:
Mother’s Name:
Age:
Mother’s Occupation
:
Sibling Name:
Age:
School (if attending) :
High School:
Graduation Date:
Address:
Phone:
City: Class Rank
State: (Please attach transcript of grades)
Zipcode:
:
College, Technical School or other Post-High School Program planning to attend:
Major/Area of Study: Please return to:
Application must be received no later than March 1, 2018 to be eligible. Lindsay Sankey, P.O. Box 516, Richmond, IN 47375 or [email protected] Phone: 765.962.1527 | Fax: 765.962.3855
Agricultural Scholarship Application Page 2 of 4
Work Experience - Please list any jobs that you hold or have held: (Employer, Position and Length of Employment)
Other Scholarships or Grants you will be receiving: Name:
Amount: $ $ $
Please provide information about your local newspaper: Name: • •
City:
Phone:
On the attached sheet of paper, list extracurricular/leadership activities. On the attached sheet of paper, prepare a short statement regarding your future career plans .
I understand that I am voluntarily releasing the above information to Harvest Land Co-op, Inc. for the purpose of applying for a scholarship for the upcoming academic year for an agricultural related program. Harvest Land Co-op is authorized to review the information in this context.
semester, quarter or term.
Signed
Date
Application must be received no later than March 1, 2018 to be eligible.
Agricultural Scholarship Application Page 3 of 4
Extracurricular/Leadership Activities Student’s Name: Please list pertinent extracurricular/leadership activities, providing a brief explanation if necessary. (Additional sheets may be used.)
Application must be received no later than March 1, 2018 to be eligible.
Agricultural Scholarship Application Page 4 of 4
Future Career Goals Student’s Name:
(Please limit the statement to this page.)
Application must be received no later than March 1, 2018 to be eligible.
